Steroid joint injections

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist
Next review due September 2023

Steroid joint injections are medicines given into your joints to reduce inflammation, ease pain and allow your joint to move more easily. Your doctor may offer you a joint injection of a steroid medicine if you have a painful joint from arthritis, for example. They’re usually given in addition to other treatments for painful joints.

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About steroid joint injection treatment

Steroid (also known as corticosteroid) joint injections work by reducing inflammation, which is the cause of swelling and pain. The steroid medicine is injected directly into the affected joint.

There are several different steroid medicines which may be chosen, including hydrocortisone, methylprednisolone and triamcinolone. Methylprednisolone and triamcinolone are stronger than hydrocortisone. You can ask your healthcare professional to explain which is the best option for you.

Steroid injections can treat many different joints including the knee, shoulder, elbow, ankle, wrist and hip. Your GP may give you the injection at your local practice. Or a physiotherapist, rheumatologist or orthopaedic surgeon or nurse may do it in a clinic or hospital. Steroid joint injections are only given by healthcare professionals who have been trained to do these procedures.

Steroid joint injections won’t cure the underlying problem or condition affecting your joint, but they may ease your symptoms. They’re often used alongside other treatments, such as other medicines (tablets) and physiotherapy. If you’re having physiotherapy treatment, steroid joint injections may allow you to cope better with this.

You may get between three weeks and three months’ pain relief from a steroid joint injection, though this varies. You can have the injections every three months if you need them. Generally, it’s best not to have more than four steroid joint injections in a year into any one joint. This is because there’s a chance any more could damage your joint.

Preparing for a steroid joint injection

Your doctor or healthcare professional will explain how to prepare for your procedure. They may give you an information leaflet with details about steroid joint injection treatment.

Let your doctor know about any medicines you’re taking. If you take a medicine that thins your blood (for example, an anticoagulant such as warfarin), your risk of bleeding into the joint is higher. So, you may need to have a blood test before a steroid joint injection to check how well your blood clots. For a similar reason, it’s important to let your doctor know if you have a health condition that affects the way your blood clots – for example, haemophilia.

It’s also important to let your doctor know if you have diabetes. This is because a steroid joint injection may raise your blood sugar for several days. See ‘Diabetes and steroid joint injections’ in our section about recovery.

You don’t usually need to make any other special preparations before you have a steroid joint injection. It’s best to wear comfortable clothes that allow easy access to the joint that you’re having injected.

Check with your doctor or healthcare professional if you’ll be able to drive after your joint injection. It’s a good idea to ask friends or family for a lift home. If you have a local anaesthetic, your joint area might feel numb so it might be difficult to drive.

Also, be prepared to rest the affected joint for a day or two afterwards. Make sure you get everything you need and stock your fridge in advance.

Your doctor or healthcare professional will discuss with you what will happen before, during and after your procedure, and any pain you might have. If you’re unsure about anything, just ask. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You’ll be asked to do this by signing a consent form.

Alternatives to a steroid joint injection

Alternative treatments to steroid joint injections will depend on what’s causing your pain. They may include steroid tablets, anti-inflammatory and painkilling medicines and physiotherapy. Ask your doctor about the options available to you.

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Having a steroid joint injection

Your doctor will examine your joint and thoroughly clean your skin with an antiseptic.

They might give you an injection of local anaesthetic to take away the pain you can get from a steroid joint injection. If you’re having a local anaesthetic, your doctor or healthcare professional will inject this into your skin first. They’ll then wait for three to five minutes for it to work.

If there’s fluid in the joint, some may be taken out with a syringe (aspirated) to make the joint more comfortable. The fluid will be sent to a laboratory for tests. This is most commonly done for swollen knees.

Next, they’ll use another needle to inject the steroid medicine. Sometimes, they’ll give the local anaesthetic as a combined injection with the steroid using a single needle.

For certain joints, your doctor or healthcare professional may use ultrasound during the procedure to help guide the needle into the right spot.

What to expect afterwards

If you have a local anaesthetic, the pain in your joint will ease within a few minutes. Your joint may remain pain free for up to two hours, depending on which anaesthetic medicine was used. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You’ll usually be able to go home when you feel ready. It’s best if a friend or family member can drive you home.

Recovering from a steroid joint injection

As the local anaesthetic wears off, be aware that the pain in your joint may be worse than before you had the injection. This pain is due to inflammation caused by the injection itself – sometimes called a ‘steroid flare’. This may last for a day or two. And it can take a while for the steroid to start working to reduce inflammation and ease pain.

You might find it helps to put ice on the area for the first few hours after your steroid joint injection. Use an ice pack or ice wrapped in a towel to reduce swelling and bruising. Don’t apply ice directly to your skin. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may need to rest your joint for a day or two, and not do anything strenuous for up to five days. Ask your doctor or healthcare professional for advice on what you should do and if you’ll need some time off work. It’s really important to follow their advice.

Most people don’t have any problems after steroid joint injections, but see our sections on possible side-effects and complications. Contact your GP if your joint feels hot or if the pain doesn’t settle after the first couple of days.

Diabetes and steroid joint injections

If you have diabetes, you may find that your blood sugar rises for a few days after your injection. Pay extra close attention to your blood sugar level for two weeks after a steroid joint injection. If your blood sugar level doesn’t settle, contact your doctor or specialist diabetes nurse for advice.

Side-effects of steroid joint injections

All treatments can give side-effects. These are the unwanted but mostly temporary effects you may get after having a treatment.

Side-effects of steroid joint injections may include:

  • more pain and swelling in the injected area – this usually settles within a couple of days
  • feeling hot or having a flushed or red face – this usually only lasts for a few minutes but can last an hour or two
  • temporary problems with your blood sugar control, if you have diabetes

Complications of steroid joint injections

Steroid joint injections are common procedures, and are generally thought to be safe. However, as with every procedure, there’s always the risk that a steroid joint injection could bring complications. Complications are when problems occur during or after the procedure.

Complications of steroid joint injections can include:

  • an infection within the joint or in the tissues surrounding it
  • damage to the cartilage within your joint or tendons around it – this may be more likely the more injections you have
  • thinning or a change in the colour of your skin around the injection site – this tends to happen more often with stronger or repeated injections; it improves with time
  • irregular periods in women or vaginal bleeding even if you’re past the menopause
  • changes in your mood – you may feel really good or very low

Ask your doctor or healthcare professional to explain how these risks may apply to you in your particular circumstances.

Frequently asked questions

  • Yes, steroid injections are sometimes used to suppress inflammation and relieve pain in the condition known as juvenile idiopathic arthritis. This is the most common type of arthritis in children.

    Some children, particularly young children, may need to have the steroid injections under general anaesthesia or sedation. The injections may relieve symptoms in these children for six months and sometimes longer.

  • Steroid joint injections aren’t usually used as a long-term treatment. They may help to ease symptoms such as pain, stiffness and swelling, and make it easier for you to have other treatments such as physiotherapy. Or your doctor may offer steroid joint injections to ease your symptoms while you wait for other treatments to begin working.

    Your doctor may suggest that you have a limited number of injections in each affected joint. This is to prevent possible damage to your cartilage and tendons (for more details, see our FAQ: How often can I have a steroid joint injection?)

    If you still have pain or swelling after a course of steroid injections, speak to your doctor about alternative treatments.

  • It’s thought that having repeated injections of steroids into your joints might cause damage to the cartilage covering the ends of your bones. To reduce the chance of this, your doctor will suggest you have as few injections as possible to ease your symptoms. They’ll also try to leave a gap of at least three months between injections into the same joint. And it’s recommended that you should have no more than four injections into any one joint in a year.

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Related information

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    • Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist, September 2020
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, September 2020
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist
    Next review due September 2023